| NPI | 1982271912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: PA SW132909) |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2022-04-04 |